Question:
CAN EXCLUSIONS BE ADDED IN THE MIDDLE OF APPROVAL PROCESS
WHEN I APPLIED FOR MY WLS WITH MY INSURANCE CO. THERE WAS NO EXCLUSION IN THE POLICY. WHILE I WAS GETTING THE ADDED IMFORMATION THEY WANTED ( THAT INCLUDED APP. WITH THREE DIFFERENT DOCTORS ) MY EMPLOYER ADDED A WLS EXCLUSION INTO OUR POLICY. I'M SURE THIS WAS TO KEEP ME FROM HAVING THE SURGERY AND MAYBE RAISING THE COST OF THEIR POLICY. IS THIS LEGAL ? IN THE STATE OF INDIANA — LINDA N. (posted on May 3, 2002)
May 3, 2002
Did you tell your employer you were planning on having this surgery? I
don't think it is legal for the insurance company to divulge this
information to them without your consent. I'm anxious to see how this
turns out for you and what someone with more legal knowledge than myself
has to say. Good luck.
— K. Joyce Smith
May 3, 2002
I'm not sure about Indiana, but in Florida we have A Comissioner of
Insurance and the Department of Insurance in the state. I would check and
see if you have one of those agencies and they should have a customer line
you can call to find out. If your state has a web page, it may have a link
to find the agency. Sorry couldn't help more
— Cheryl S.
May 3, 2002
This will take you to the Department of Insurance in Indiana.
http://www.in.gov/idoi/
— garw
May 3, 2002
I would report this to the Indiana insurance commission. From what I
understand about Indiana Law (I am in Michigan but my insurance is out of
Indiana). They have the law that insurance must cover WLS if you meet NIH
guidelines and have been MO for 5 or more years. Also I would contact
Walter Lindstrom (obesitylaw.com) to see if they have any information they
could give you about this.
— Dell H.
May 4, 2002
Linda, in regards to your post concerning WLS and Indiana State Law. The
state of Indiana has passed a law that health care providers in the state
have to offer coverage for gastric bypass surgery for the morbidly obese
they insure if: (1) The procedure you're requesting is not experimental
(2) The morbid obesity has persisted for at least 5 years.
(3) That non-surgical treatment has been supervised by a
physician for at least 18 months and has been unsuccessful.
In the law Morbid Obesity is defined as:
Weight of at least 2 times the ideal weight for age, frame,
height and gender
BMI of at least 35 with co-orbidities
BMI of at least 40 without co-morbidities
This applies to policies or contracts in Indiana issued, entered into, or
renewals after 6/30/2000.
I believe this is the website address, if you wish to read the law in it's
entirety:
www.state.in.us/serv/lsa__billinfo?year=2000&request=getBill
&docno=0212. Hope this helps, Jo-Dee Hortz
— tinyjo
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